Urticaria (hives) treatment

There are several options for treating urticaria.

Avoiding known triggers

Triggers. It’s important to try to avoid any known or suspected causes of urticaria. (While it is often possible to determine the cause of acute urticaria — urticaria that lasts hours, days or a few weeks — the cause of chronic urticaria, which lasts longer than 6 weeks, and may last for months or years, is often unknown.)

Exclusion diets. Do not undertake a widespread exclusion diet unless a food trigger is confirmed. Elimination diets need to be carried out under supervision.

Salicylates, found not only in aspirin but also certain fruits, and food additives such as tartrazine and benzoates are relatively common triggers. Aspirin can often make symptoms worse.

Oral antihistamines

Oral antihistamines are usually the main treatment for urticaria. They can relieve the itch and control the rash in most people. Non-sedating antihistamines are preferred, because they are effective, have few side effects and generally do not cause drowsiness.

Sedating antihistamines (the types that make you drowsy) should be used only if the itching is severe and sedation would be useful, for example, at night. It is vital that you are aware of the sedating effects and the risk of driving or operating machinery while taking these medicines, as reaction times may be reduced significantly.

Combination of antihistamines. Sometimes, a combination of antihistamines works better than a single antihistamine on its own.

Anti-pruritic (anti-itch) preparations

Application of topical anti-pruritic (anti-itching) lotions and creams, such as calamine lotion, may provide relief of symptoms. Ask your doctor or pharmacist for advice.

Medicines used for severe urticaria

Antihistamine injection. An antihistamine injection is sometimes required to treat extensive urticaria, or severe urticaria that involves the eyelids and lips.

Corticosteroid medicines are also sometimes used to treat more severe cases of urticaria. Oral corticosteroids can help lessen swelling, itching and redness.

Adrenaline/EpiPen. In cases of severe urticaria that is associated with anaphylaxis (a life-threatening allergic reaction), you may need an emergency injection of adrenaline. People who are prone to anaphylaxis need to carry an EpiPen (a device that can be used to give a shot of adrenaline in an emergency situation) with them at all times.

Self-help

If you know what causes the urticaria, avoid it.

If aspirin precipitates urticaria it is important to see a doctor before using any other non-steroidal anti-inflammatory (NSAID) medicine.

A tepid shower or cool cloth may be soothing. However, heat may make the itch worse.

Sitting next to a fan may be cooling and soothe the rash.

Avoid tight clothing as the pressure may worsen the weals and the itch.

Antihistamine medicines are often helpful. If the urticaria does not respond to an antihistamine, see your doctor.

When should you seek medical advice?

You should seek medical advice if:

urticaria occurs in a child under 12 years old;

it lasts longer than 24 to 48 hours;

it occurs more often than just occasionally;

it covers a large area of your body;

the hives don’t respond to treatment;

you also experience fever or general unwellness; or

there is marked swelling, especially if your face, eyes, lips or tongue are involved, or if there is any associated wheezing. In this case seek medical advice urgently.

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